So I was reading through some old threads that discussed the confusion that exists between MAC, TIVA, GA, etc. The confusion is defining a "heavy" MAC versus minimal/moderate sedation versus a IV general. So, as a new CRNA I continually find myself in unfamiliar territory and would like some feedback. If you have a cardiologist performing a TEE without anesthesia involvement(minimal sedation) and then call for assistance because the patient isnt tolerating the procedure....what do you do? I'm not familar with the consent that the cardiologist has the patient sign for the procedure but once anesthesia is called a pre-op must be performed, informed consent must be obtained, etc. If the patient has already been medicated then this obviously complicates things.

Would you just refuse to assist and have the procedure rescheduled with anesthesia or proceed with physical assessment, chart review, family member sign consent, and administer anesthesia as needed? Are there other appropriate ways to handle this situation? I had a situation like this come up and asked several different CRNA's and MDA's how to address this and recieved several different answers....

The TEE was being performed on a 32 year-old IV drug abuser with endocarditis. The cardiologist obviously didn't deem it an emergency but really wanted to complete the procedure.